<!DOCTYPE>
<html>
<head>
<meta charset="UTF-8"/>
<meta name="viewport" content="width=device-width,initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no" />
<link rel="stylesheet" type="text/css" href="css/common.css"/>
<link rel="stylesheet" type="text/css" href="css/put_forward.css"/>
<script src="js/jquery-1.11.3.min.js" type="text/javascript" charset="utf-8"></script>
<script src="js/common.js" type="text/javascript" charset="utf-8"></script>
<script src="js/put_forward.js" type="text/javascript" charset="utf-8"></script>
<title>佣金提现</title>	
</head>
<body>
<div class="item">
	<div class="name">开户人姓名:</div>
	<div class="input"><input type="text" id="name" placeholder="请输入真实姓名"></div>
</div>
<div class="item">
	<div class="name">开户银行:</div>
	<div class="input"><select id="bank">
		<option value ="0">请选择开户银行</option>
		<option value ="1">建设银行</option>
		<option value ="2">农业银行</option>
		<option value ="3">工商银行</option>
		<option value ="4">中国银行</option>		
		<option value ="5">招商银行</option>
	</select></div>
</div>
<div class="item">
	<div class="name">银行账号:</div>
	<div class="input"><input type="text" id="banknum" placeholder="请输入银行卡号"></div>
</div>
<div class="item">
	<div class="name">银行所在省:</div>
	<div class="input"><input type="text" id="bankp" placeholder="请输入银行所在省"></div>
</div>
<div class="item">
	<div class="name">银行所在市:</div>
	<div class="input"><input type="text" id="bankc" placeholder="请输入银行所在市"></div>
</div>
<div class="item">
	<div class="name">开户行详细地址:</div>
	<div class="input dz"><input type="text" id="bankadd" placeholder="请输入详细地址"></div>
</div>
<div class="item">
	<div class="name">手机号码:</div>
	<div class="input"><input type="number" id="tel" placeholder="请输入您的手机号"></div>
</div>
<div class="item">
	<div class="name">支付密码:</div>
	<div class="input"><input type="password" id="paypassword" placeholder="请输入支付密码"></div>
</div>
<div class="item">
	<div class="name">联系QQ:</div>
	<div class="input"><input type="number" id="qq" placeholder="请输入您的QQ号"></div>
</div>
<p>以上信息为必填</p>
<div class="btn">确定</div>
</body>
</html>
